Transcript

Norman Swan: Mindfulness meditation based on centuries of Buddhist meditative techniques is growing in popularity as is its evidence base. Dr Craig Hassed’s been promoting it for years. He’s in the Department of General Practice at Monash University in Melbourne and is founding President of the Teachers of Meditation Association.

Craig has co-written a book on the subject called Mindfulness for Life.

Craig Hassed: Pretty much every form of meditation is a form of training attention in one way and another and mindfulness perhaps differs from others in that it uses the senses, in particular to train the attention on, whereas other forms of meditation use other things. It could be mantras or other visualisation exercises, so mindfulness uses the senses and the thing about the senses, it is very much in the present moment, very much connected to and engaged with the environment. But at the same time it also shows us a lot more about what’s going on in our own minds.

Norman Swan: Because the idea here is to clear your mind but not fight against the thoughts that might intrude when you’re trying to focus on whatever object you might be focussing on.

Craig Hassed: Yeah, there’s a bit of a Catch 22 because the mind tends to remain active whether we want it to or not and so when we get annoyed about the fact that thoughts are coming in, particularly the ones that we don’t like having, then we get reactive to them. And the funny thing is the more we struggle with them the more it fixates the attention on the thoughts that we don’t want to have. So in a funny kind of way the clearing of the mind is through not being concerned about the business of the mind but learning to be more accepting, less reactive to it, but just gently re-connecting the attention with wherever it needs to be. So during a formal practice that might be with say the breathing or with the body, but to be mindful when you get out of the chair is to take that awareness back into your day to day life.

Norman Swan: So just describe it to us in a bit more detail, just in terms so we’ve got a clearer picture of what it is.

Craig Hassed: Mindfulness meditation is a formal practice, it just involves sitting in a chair, a balanced and upright position of the body and then just gently moving your attention through various parts of the body. So that’s called the body scan if you like, so the attention might be moved from say the feet, to the legs, to the stomach and so on up to eventually maybe the head. And then you could gently let the attention rest with the breathing so that the actual sensation of the breath as it enters and as it leaves and it’s often as the attention wanders off, not judging, not criticising it, but just noticing and just gently bringing the attention back. So that’s the attention training, the attention regulation, a bit of the practice.

Norman Swan: There’s an exercise and I’ve broadcast this before, there’s an exercise with a raisin that some people get to do.

Craig Hassed: Yeah well any of the senses can really be used to train the attention and to help to bring the mind back into the present moment. Because the senses only ever operate in the present moment so they are a great window back to the present moment. The raisin exercise made famous by Jon Kabat-Zinn gives people a raisin to start off with and people just use every one of their senses to investigate that particular object. Some of the friends I have who do some corporate training don’t do the raisin exercise. They do the Lindt chocolate exercise. Obviously in a corporate environment they have a different sense.

Craig Hassed: Yeah, and I mean if a person really enjoys wine for example and they go to a wine tasting they use everyone of their senses to investigate the experience of drinking and enjoying the wine, to savour it and that’s almost like a practice in mindfulness itself. If a person stops drinking the wine in time they remain mindful, if they go on too far well then they cease to be so mindful.

Norman Swan: But recently on the Health Report we had somebody using mindfulness meditation for chronic pain, in this case it was vulval pain, genital pain in women. The way she used mindfulness was to use the pain as the focus and to analyse the thoughts associated. So in other words there’s an analytical component sometimes when you use mindfulness meditation therapeutically where you examine the thoughts that might come into your mind when you’re trying to clear it and focus on one thing.

Craig Hassed: Yes exactly, because if we just think of it as a relaxation exercise then we are actually missing the point. It’s an exercise in paying attention and noticing what’s going on. So if a person experiences something that’s painful, now it could be physical pain but it could also be emotional pain say in the context of depression or anxiety or fear, that as a person pays attention, then let’s say the physical pain, noticing the physical pain then one pretty quickly notices a whole range of emotions and reactions and anticipation arising around it, ‘I hate it, I wish it would go away, is it going to get worse, what’s the rest of my life going to be like’, and so all of this mental and emotional reactivity, all of this anticipation actually accentuates enormously the suffering associated with the pain. So as a person learns to be mindful with the pain one learns to just observe it as a sensation, no more, no less than what it is, but less and less intruded upon by all of the thinking and the reacting around the pain effect.

Norman Swan: How much analysis, I mean I’ve spoken to some mindfulness meditation practitioners or therapists who say that if you’re actually going to do it for depression or pain or something like that you’ve really got to do it with an experienced guide so that you deal with the thoughts in a constructive way rather than just doing it yourself. What’s your view about that?

Craig Hassed: Well I think that the more direct guidance one can get from an experienced teacher of mindfulness then the better. It doesn’t mean to say a person can’t learn by themselves, or read books and find them valuable, or use tapes of CDs, but very often in our practice we will come up against particular barriers. So we’re trying to use the mindfulness to get rid of the pain and we’re not actually practicing an acceptance of it we’re practising a non-acceptance which is masquerading as acceptance.

Norman Swan: Meaning there’s no point in trying to get rid of the pain. The issue is dealing with the pain better.

Craig Hassed: Yes, so when a person says ‘oh look, I practice mindfulness, I try to practice accepting the pain but it didn’t work, it didn’t go away’. Then you can ask ‘well was that acceptance of the sensation or was that non-acceptance with a veneer of acceptance over the top’? And very often these kinds of traps I suppose unless a person is guided through that, they may not actually be aware that with the best will in the world they think they’re practicing mindfulness when they may actually be practicing the opposite of that.

Norman Swan: So a lot of it is about expectations here, it’s not like it’s good for you to accept, it’s that you’ve got the pain, one day it might go away but at the moment let’s just deal with it so that all you’ve got is the pain and not all the mushroom cloud of stuff that goes with it.

Craig Hassed: Yes, it doesn’t mean that it won’t change but yes it is experienced as no more and no less than what it is because what tends to happen is we amplify it and expand on the pain enormously which increases the burden associated with it. So getting out of that cycle takes a lot of patience, quite a lot of courage actually, but it bit by bit undoes a pattern that may have been the opposite ...

Norman Swan: But is there a danger of making things worse if you deal with the thought, the intrusive thoughts in an unconstructive way?

Craig Hassed: Well a person can for example if experiencing pain or experiencing anxiety and getting reactive to it and trying to make it go away then a person might notice that they have some rebound anxiety and can accentuate it. Now if the person is being guided and encouraged through that then it’s not like viewing that as oh, that’s a bad or a wrong experience, the person just notices what was arising, what was the response, what effect that response had, so that they can notice ‘alright, well OK, if I try and get rid of it then it can accentuate, if I learn to be comfortable in the presence of that pain or that anxiety then it reduces the impact of it’. And that same thought or feeling of sensation can come and pass more and more readily without getting us so hooked on it on the way through.

Norman Swan: What’s the advantage to being focussed on the present because in many ways we are all the sum total of our past?

Craig Hassed: Well we are and we find that the products of the past, past hurts and mistakes and everything else do tend to present themselves in the mind in the present but the only opportunity we have to do anything constructive about it is in the present moment. In the same way we could be worrying about the future but the only opportunity we have to act consciously is in the here and the now. We don’t want to be prisoners of our past and we don’t also want to be anxious about a future event that hasn’t happened yet.

Norman Swan: How long does it take to get good at it?

Craig Hassed: Good at it - when we’re getting anxious about progress we actually get in our own way so to be good at it also includes not being preoccupied about being good at it but just practicing the process and just allowing the accumulated benefits of the practice to operate in their own way. A person can start to notice within a week or two they will be more aware of how busy the mind is, how the many reactions and so on are going on, within two or three weeks the person is more aware of those but getting less and less drawn into them. Four of five weeks they may well start to notice getting less reactive to the things that they previously did and so if a person was doing a six week course, generally over the six weeks the person will start to notice significant changes. So long as they have actually been practicing and applying it.

Norman Swan: It’s worked.

Craig Hassed: Yes, it does take effort, it does take some insight and motivation but at the end of a six week course it’s not the end of it, it’s giving a person the tools and the means throughout their life to continue to practice and apply and deepen their understanding of it.

Norman Swan: I’m speaking to Dr Craig Hassed from Monash Medical School Department of General Practice who has written a book with Dr Stephen McKenzie called Mindfulness for Life and we’re talking about mindfulness meditation. How long each day do you do it for, and how many times each day?

Craig Hassed: There’s no one answer to that question. In the context of severe depression or major chronic pain in some of those clinical trials people were practicing for about 40 minutes a day. There are a lot of other studies that are suggesting that people can in the normal run of things with just the day to day stresses and less severe problems that even 5 or 10 minutes say a couple of times a day can start to produce significant benefits. But it is important to underpin the principle that the formal practice of mindfulness meditation is a way of underpinning getting out of the chair and living mindfully.

Norman Swan: What do you mean by that?

Craig Hassed: There’s no point in being present in the chair for 10 minutes or 40 minutes and then getting out of the chair and being constantly distracted again. I’ve just come from speaking to business and economic students at Monash University about this. The students realise that when they get anxious about exams and they are sitting in front of their books their focus is not on the books or their notes on whatever they are trying to do to prepare for the exam. The attention is actually being siphoned off in worrying about how they are going to go. Not only is that a distraction that causes them a lot of worry but it actually wastes the time that they need to prepare for the actual event. So it’s to be mindful while studying means to focus on what you’re studying and to unhook the attention from the anxiety about the outcome. To be mindful on the starting blocks of an Olympic race means to focus attention on what you need to do with your body and your movement and the fluidity of the movement rather than focussing on the anxiety of disappointing yourself or others.

So to be mindful is really a way of living, to taste our food, to just when walking the dog just walk the dog – no more no less; mindfulness in day to day life.

Norman Swan: So give us the evidence base?

Craig Hassed: The biggest area that’s created more interest I would say is in the mental health field. So for preventing a relapse of depression, I also work with eating disorders.

Norman Swan: Insomnia?

Craig Hassed: Yes insomnia, many people would know this, you go to bed and then your mind is giving you a re-run of everything that’s happened that day, or worrying about tomorrow, it can just help a person to unhook attention from all of those thoughts and to just come back to the present moment and allow that wave of sleep to just come a bit more naturally. There’s another area to do with, as we were talking about before, chronic pain, coping say with things like cancer the metabolic and hormonal effects and also some of the interesting work of Elizabeth Blackburn and her group.

Norman Swan: This is the Nobel Laureate, the expatriate Australian who studies these things called telomeres at the end of chromosomes which get shorter with ageing and also with stress and pollution and things like that?

Craig Hassed: That’s right and her and her lab have been involved with now three trials that have found that mindfulness training seems to be repairing or helping the DNA to repair itself which has implications for ageing and chronic illness.

Norman Swan: OK Craig, you’ve got a national audience now, probably some people are in the car, so we don’t want them to fall asleep or drive into a lamp post, but take us through an exercise now for the national audience; let’s do mindfulness meditation on Radio National live.

Craig Hassed: Alright well just sitting balanced in a chair and just being aware of the body now.

Norman Swan: Are my eyes shut?

Craig Hassed: Yes, so just being in touch with the body now, noticing those sensations taking place here and there. You might like to let the attention gently move down to the feet and noticing whatever sensations are taking place there, whether it’s the shoes, or the socks against the skin and those sensations might be very subtly changing from one moment to another. And then just letting the attention gently move to the legs, so noticing the arms on the lap, or the clothes on the skin and the stomach and in the process of paying attention from moment to moment we might notice thoughts coming and going in the mind. There’s no need to even think that the thoughts shouldn’t be there, there is no need to try and get rid of them, but just noticing them and letting them come and go by themselves without having to do anything about them. And as often as the attention wanders just gently bring it back and at this moment it just happens to be to the stomach, now the hands and the arms, it’s being in touch with them and also the neck and the shoulders and the head. And one particular sensation just taking place from moment to moment is the breathing, so just letting the attention gently rest with the breath and feeling the air as it enters and as it leaves; and once again as often as the attention wanders just noticing and gently bringing the attention back. Even if there’s a judgement or a criticism about the attention wandering, just noticing that and the effect of it and gently allowing the attention to connect with the breath once again.

Good, so on completion of that exercise then when you’re ready just allowing the eyes to gently open and then just mindfully, attentively, move into the day to day activities that await you. So that was a practice then over perhaps a couple of minutes but obviously those steps and those pauses in between would obviously be lengthened out with longer periods of silence.

Norman Swan: Craig thank you, I’m feeling like a new man.

Craig Hassed: Thank you very much Norman, same here.

Norman Swan:Mindfulness for Life is published by Exisle and is by Craig Hassed and Stephen McKenzie.